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HomeMy WebLinkAbout16665 (35) _ _�.� CITY OF DIAMOND BAB � � DEPAR�'MENT OF COIVIIVIUNITY,&DEVELOPMENT SERVICES a 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(409)861-3117 PRES$ `"':A�'... Buu:nnvG P��rr arr�,icATiox FIRMLY - _ _ - � JOBSITE "'�"�� !� ' b���/° ��4� ��� � ADDRESS � APPLICATION ' � � `"'�� PERMIT ��} � P/C DATE � NUMBER �' # � ISSUE � =� /`") TYPE OCC APN LOT�---� -- TRACT�- DATE �� CONST. GROUP p OWNE��I?1.�/�a CG:.�I`I �iL'� l� ` � ADDRESS;.,�- ZONMG SETBACKS z CtTY �� ZIP � TEL. FRONT RW ❑ � APPLICANT TEL. REAR ❑ Z SIDE/SIDESTREET RW OT � CONIRACTO , � .' �(� �� SIDE ❑ � ADDRESS PROPOSED USE � CITY � .�1�' ZIP TEL: f 1 � ARCWENG/ I �z DESIGNER NO.DV+�EL. NO. NO. ri AD�RESS UNITS STORiES BEpROOMS � CITY ZiP 7EL. N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATIQN �� � � � O!NNER-BUILDSR DEGLARATfON �, SFRlADD/REM - � � O p I MEflEBY AFFlRM UP87ER PBdR,LTY OF PERJUflY 7NAT!AM EXEMPi FROM TNE CONTMCiORS LI� ' GEMd(JB/COfpOff ' ll1�� .'�CENSEUIWFORiHEFOLLOWING�REASON(SEC.7o31.5BU51NE43ANDPRO'rE5510N5CODE:ANYCITYOR (n � � I�ry}yyh{ICHPEDUIRESAPERMtTTOCONS7RUCT,AL7ER,IMPROVE,DEMOLiSH,ORREPAIf1pNY5TRUG W P0410/DECIC ' ' , W �''7UHE,PRIOR TO ITS ISSUANCE.IV.SO REOUIRES THE APPLICANT FOR SUCH PERMI7 TO FILE A SIGNED �w !,STATEMENT 7HAT He OR SHE IS IICENSFO PURSUANT TO THE PHOVISIONS OF TNE CONTRACTORS LI- �' "���CENSE LAW(CHAPTER 9�C00.N4ENCWG'i WITH 5ECT10N 7000)OF�IVISION 30F THE 6U51NESS AND VRo. u' PCOI/Spd � r� .I�FESSIONS�OE)ORTHATHEORSHEI$EXBAPTTHEREFROMANOTFfEBASISFORTHEALLEGE�EXEMP� �(3 �, V TION.MIYYbLAT101VOFSECTION'7037.5BYANYAPPLICANTFORAPEAMITSU&IECiSTNEAPPUCANTTO � RB-R00( � � ACIV{LPENALTYOFNOTMORE7F{ANFIVEHUNCREDDOLIARS�P5a0j.): ��. ' f]I,ASOWNERDFTHEPROP�RTY,OflMYEMPLOYEES141THWA0ESA5THEIR50lECOMPENSAT{ON, �C� C01111II8fCl81 � ^ . � � '�WILL DO THE WORK,AND THE STAUCTURE FS NOT IYfENDED OR OFFERE�FOR SALE(SEC.70ba,eU51- J � I��NES6MID PFpFESSbNS COD6:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � , ' . '� ,,'IPflOPERTYWHOBUILD50RiMPAOVESPHEAEON,ANOWHODOE55UCHWOflKHIMSELFQRHEqSELFOR (S'. ��,TNfi9U(iHHI50P.HEROWNEMPLOVEES.PROVIDC-0THA75UCHIMPWOVEMENTSARENOTINTENOE�Oft m . Q.,,;�'1�fFEFEDFUA SALE IF,kObYEVER R1�E BUILDING OR IMPFDVEMENTIS SOID WITHINONEYEr1ROF COMPLE� �' ���TION,THE OVlNER�BUILOER WII.L HAVE TY.c BURDE�4 OF PROVING THAY HE oq SHE DID NOT BUILD OR � 1 .��. . !IIMPROYEFORTFIEPURPOSEOG5PL�E9•�' w ' �0�,:4SOWNEAOFTHEPROPERYY,hMEXCLUSIVELYCONTRACTINGWITHLICEN6mCONiRACTOR3 � � ITp CONSTRUCT THE PRQIEC7(S€C.7o4i,B/1SINESS AND PROFESSIONS CADE:iHE CON i RACiORS LI- Vdlu&flon ADJ.AREA GS.I �CENSELAWDOESiVOTAPPLYT0ANO4MEAOFAPHOr�ERTYWHCBUILpSORIMPP.OVESiHEREON,AND , 2 �,NA�OCONTRACTSFORSUCHPROJEG75FVITHACONTR.ACTOR(S�IICENSEpPURSIlAHT7DiHECONdRAG (]UANTI7Y DESCRIPTION FEE � X ""ORSUCENSELAW.). � C I AM EXEMPT UNDER SEQ_,_ ._B.&P.0 FOH THIS REASQN U � � S ' � �"'. �APE .OWNER }" Z ! � Q LICENSED GONTRFlCTORS 6ECLARATIOPJ � � IHEREBYAFFIpA1UNDEflPENAL?Y�Of-PERJURYTHA7IAMLIC6NSEDUNDERPROYISIOMSOF^�•1-IAPTER � . -%"4- , ' g. 9(COMMENCINGWITHSECTI049np0)OF�iVISION30FTHE0USIt�ESSANDApO�ESSIONSCO�E,flND � IJ �X� .kN UCENSE IS IN FULL FORGEAND�,EFFECT. � 11 . . � �. �1 gy}�/ � � LICENSE G . LIC.NO. '�++ F � � � V, GATE � CONTAACTOR �o- W � WORkERS'COMPENSATION C7EClARATION J �� y �7HGRE9YAFFIAF1UNDc'RPEN4LTYbFPEPJURVONEOFTHEFOLLOWINGDECLAFATION& ¢ C� Q C� �IHdVEANDWIiLMAINTAlNACERTIF!CA7EOFCONS'cNT70SELF-Ih'SUREFORWORKERS' x - � COM?EN^wATION,AS PFlOVI[�ED 8Y SECTION 370D OF THE LABOR CODE,FOR THE PERfORMANCE U ¢ O�SHE WOFK FOR WFACN TIiIS PEFMIT IS ISSUED. � w '��IHAYEANUWIIIMAINTAIN1�dOPoLEH9'COMPENSATIONINSURANCE,ASREQUIREDBYSECtIOM � 37d00F7HELPEQRCA�E.FORTHEPERFpRMAtdCEOFiHEWORKFORWHICHiHISPERMI7IS �,I55UEQ:MY WARI(ERS'f%)MP NS'TIQN INSU ANCE CARRIERAND POLICYNUMBERARE: CONSTRUCTION "�� CAARiER_,..� �I ' ` ���� �y, PLAN REV!EW �� POLiCtl NUFABEFl � ,r� ,��1 f�'� E!_ECTRIC � � fri��sse-Gmaara��noreeoa+�Ergocf-�aear,�r�sFoaaveHuwnEo�waslsiwlaa�Ess1. PLUMBPNG tr�i9; T !CERTIFYT}iAl'W TFiF PEftF�OfliF.PNCE OFTNE WOflK FOH WHICH THIS PERPAIT IS ISSUE�,1 MECHANICAL [,�^ , SHAL..NDPEM?I.OYAPlYPER�SOiVijryp4yMANYER50n5iO8ECOM'cSUBJECTiOTHE �',' WOP.KERS'COMPENSATIONLfiWS��OFGALIFORNIA,ANDAaREETFATiFI5H6ULDBECOME 7NSPEC710NFEE SUBJECT YO�THE WORKERSai COMPEN^oA?ION�p0415iON5 OF SECTICN 3700 OF THE UBOR � �C6Dc SjHA'S C�yP.7HWITHCOMPLYWITHTH9S�'. OVISIO S I$SUANCE � 4. �ATE���. I�'�� �' ld� APPLICANT. I � SMIP . '�^�'�..'� WARNINa:�,FAILUElE TO SECURE WUFjKERS;COMPENSA710N COYERAGE IS UNLAWFUL,AN�&HALL BE ENERGY P!C '��„SU&IECTRN EMI?LOVER TO CRiMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED TNOUSAN� �+��� EWEFGY PERMIT y '�'�DOLLARS($10o,ofi0),1N AQDITIOW 70��,iHE C0570F COMPENSATION,DAMAGES dS PROYIDED FOR W J�.. SECi10N3y080F7HEV9CflC06E,�liNTEREST,ANDATTORNEI^SFEES. � HETENTIONFEE" LLT"; 4� '�� . CON TRUCTION LENBING RGENCY _ _ Q PRE•Al7 FEE: �����,I HEREeYAFFiRM UNDER PENALTV O�PERJURV iFIkiTHEflE IS ACONSTRUCTION LENOING RGENCY - a-�'��FOR"ME PERFOh'PAANCE OF iHE W�}lK FO,R WHICN iHiS PERMiFlS ISSUE�(S`cC.309].CIU C.�. ' '- � � . ��, ',LENtlER'SNAME , ._. . - ' _ F� LENfJER'SAOORESS� "� _ �^ . m2 O`� �,'1 ICERTIFY7HATIHAVER'cADiHISAPPLICATIONANDSTATE7HATTHEABOVEINFONMATIOfYISCARPECY. TOTAL FEES �A � ' ' �',��',;,JAGREETOCOMPLVLWITHALLL'1?VAyY�CO}1NTYOP.CIINANCESANDSTATELAWSREIAiINGTOBUIL�ING � � , . � CANSiFiUCT10N,ANDHERE6YAUTNORI2ENEPRE5EN7ATNE5�FTNISCOVNTYTOEN7ERUPONTHE . ' � �� �i ABOYE-�TIONEDPr�OPERTYFOfl�N`�PECTI�NPURP03E3. COMMENTS -� � As' �/ /' . . _ ., �i ��-- ' . . .. Q '�. 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